Lin Xiaorong, Hong Shubin, Huang Jiefeng, Chen Yi, Chen Yufeng, Wu Zhiyong
Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China.
Diagnosis and Treatment Center of Breast Diseases, Shantou Affiliated Hospital of Sun Yat-Sen University, Shantou, Guangdong, China.
Discov Med. 2017 Apr;23(127):247-258.
Strong evidence exists indicating that the risk of breast cancer (BC) occurrence is influenced by complex internal environmental factors, including blood lipid and lipoprotein components. However, the roles of these components in BC development and progression remain controversial. This study examined whether serial serum lipid and lipoprotein measurements were associated with breast cancer risk and whether lipoproteins had BC prognostic properties. We compared the plasma-related parameter levels, including lipid and lipoprotein levels between 299 patients with invasive ductal breast cancer, also known as invasive ductal carcinoma (IDC), and 200 healthy donors. We performed univariate and multivariate logistic regression analyses to assess overall survival (OS) and disease-free survival (DFS). We found that the serum glucose, triacylglycerol, and low-density lipoprotein levels were significantly higher in patients with IDC than in healthy donors. However, high-density lipoprotein and apolipoprotein A1 (apoA1) levels were lower in patients with IDC than in healthy donors. Multivariate regression analysis demonstrated that elevated apoA1 levels were associated with a reduced risk of IDC, and univariate analysis showed that patients with IDC with lower apoA1 levels at diagnosis had larger tumors than patients with high apoA1 levels. Moreover, patients with IDC with lower apoA1 levels were more likely to have positive axillary lymph nodes, and were diagnosed at more advanced disease stages than patients with high apoA1 levels. We used a Cox regression model to assess the relationships between the above parameters and DFS and OS, after adjusting for tumor T and N stages, which were determined using the TNM classification system, and immunohistochemical subtypes. We found that lower apoA1 levels at diagnosis were associated with poor DFS and OS. At 60 months of follow-up, the DFS rate is 74.5% in the apoA1 L1 group, 89.9% in apoA1 L2 group, and 93.1% in apoA1 L3 group (p=0.0002). Similarly, the OS rate is 78.2% in apoA1 L1 group, 91.3% in apoA1 L2 group, and 93.7% in apoA1 L3 group (p=0.0012). In conclusion, our data indicate that low apoA1 levels are an independent predictor of the poor clinical outcomes in IDC patients.
有强有力的证据表明，乳腺癌（BC）发生风险受包括血脂和脂蛋白成分在内的复杂内部环境因素影响。然而，这些成分在乳腺癌发生发展过程中的作用仍存在争议。本研究探讨了连续测定血清脂质和脂蛋白是否与乳腺癌风险相关，以及脂蛋白是否具有乳腺癌预后特性。我们比较了299例浸润性导管癌（IDC）患者与200名健康捐赠者之间的血浆相关参数水平，包括脂质和脂蛋白水平。我们进行了单因素和多因素逻辑回归分析以评估总生存期（OS）和无病生存期（DFS）。我们发现，IDC患者的血清葡萄糖、三酰甘油和低密度脂蛋白水平显著高于健康捐赠者。然而，IDC患者的高密度脂蛋白和载脂蛋白A1（apoA1）水平低于健康捐赠者。多因素回归分析表明，apoA1水平升高与IDC风险降低相关，单因素分析显示，诊断时apoA1水平较低的IDC患者比apoA1水平高的患者肿瘤更大。此外，apoA1水平较低的IDC患者腋窝淋巴结更易呈阳性，且与apoA1水平高的患者相比，其诊断时疾病分期更晚。我们使用Cox回归模型评估上述参数与DFS和OS之间的关系，同时校正了使用TNM分类系统确定的肿瘤T和N分期以及免疫组化亚型。我们发现，诊断时较低的apoA1水平与较差的DFS和OS相关。在60个月的随访中，apoA1 L1组的DFS率为74.5%，apoA1 L2组为89.9%，apoA1 L3组为93.1%（p = 0.0002）。同样，apoA1 L1组的OS率为78.2%，apoA1 L2组为91.3%，apoA1 L3组为93.7%（p = 0.0012）。总之，我们的数据表明，低apoA1水平是IDC患者临床预后不良的独立预测因素。
